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Cited by 219Physical Activity and HealthCardiovascular and exercise physiologyCardiovascular Health and Risk Factors

Frequent Physical Activity May Not Reduce Vascular Disease Risk as Much as Moderate Activity: Large Prospective Study of Women in the United Kingdom

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Armstrong, Miranda E. G., Green, Jane, Reeves, Gillian K., Beral, Valerie, Cairns, Benjamin J.·2015·Circulation
DOI 10.1161/circulationaha.114.010296
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Abstract

Background—: Although physical activity has generally been associated with reduced risk of vascular disease, there is limited evidence about the effects of the frequency and duration of various activities on the incidence of particular types of vascular disease. Methods and Results—: In 1998, on average, 1.1 million women without prior vascular disease reported their frequency of physical activity and many other personal characteristics. Three years later, they were asked about hours spent walking, cycling, gardening, and housework each week. Women were followed by record linkage to National Health Service cause-specific hospital admissions and death records. Cox regression was used to calculate adjusted relative risks for first vascular events in relation to physical activity. During an average of 9 years follow-up, 49 113 women had a first coronary heart disease event, 17 822 had a first cerebrovascular event, and 14 550 had a first venous thromboembolic event. In comparison with inactive women, those reporting moderate activity had significantly lower risks of all 3 conditions ( P <0.001 for each). However, women reporting strenuous physical activity daily had higher risks of coronary heart disease ( P =0.002), cerebrovascular disease ( P <0.001), and venous thromboembolic events ( P <0.001) than those reporting doing such activity 2 to 3 times per week. Risks did not differ between hemorrhagic and ischemic stroke, or between venous thromboembolic events with or without pulmonary embolism. Conclusions—: Moderate physical activity is associated with a lower risk of coronary heart disease, venous thromboembolic event, and cerebrovascular disease than inactivity. However, among active women, there is little to suggest progressive reductions in risk of vascular diseases with increasing frequency of activity.

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Crossref · 10.1161/circulationaha.114.010296

Cites

46 of 46 references verified0 citation errors · 0 not checkable

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  • Effect estimates in included studies were mostly relative measures such as hazard ratios or relative risks, though 3 papers reported absolute measures such as population attributable risk percents.

    “Effect estimates were mostly relative measures of the association between physical activity and incident stroke (either hazard ratios or relative risks), though 3 papers29,34,47 reported absolute measures of effect such as population attributable risk percents.”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [29]

    The Statistical Analyses section (page unavailable) says the paper reports hazard ratios, called relative risks, and the Results include incident stroke subtypes. It describes those ratios as ‘floated absolute risks’ for comparing categories, but our copy does not show population-attributable-risk percentages or another absolute measure of effect of the kind claimed. The count of three papers cannot be established from this source alone. (LLM, conf=0.86)

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  • Of the 28 studies in Table 2, 19 (68%) reported estimates indicating a protective effect of physical activity on risk of total stroke in women.

    “Of the 28 studies in Table 2, Nineteen studies (68%) reported estimates indicating a protective effect of physical activity on risk of stroke”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [29]

    The Discussion (page unavailable in our copy) reports lower stroke risk among more active women, consistent with the claim’s general direction. But this paper reports a prospective study of UK women, not a tally of 28 studies; our copy does not substantiate the asserted 19 studies (68%) or their placement in Table 2. (LLM, conf=0.86)

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  • One of the 17 papers demonstrated a higher population attributable risk of total stroke due to physical inactivity in women than men (63.8% vs 57.6%), but the difference was not tested for statistical significance.

    “One paper29 (of the 17) demonstrated a higher population attributable risk of stroke due to physical inactivity in women than men (63.8% vs. 57.6%), but the difference was not tested for statistical significance.”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [29]

    The Results and Table 3 report stroke associations with physical activity in women, but give no population-attributable-risk estimates for women and men. A search for 63.8%, 57.6%, and sex-specific population attributable risk found no matching passage in our copy; the Statistical Analyses section describes tests across stroke subtypes, not between sexes. (LLM, conf=0.76)

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  • Of the 37 included studies, 31 were prospective cohort studies, 3 were case-control studies, and 3 were other study types.

    “Of the 37 studies included, 31 were prospective cohort studies with the exception of 3 case control studies,29,40,49 and 3 were other study types”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [29]

    The Statistical Analyses section describes an analysis of women in a single cohort, not a set of 37 included studies. Searches for the claimed counts and study types found no passage in our copy reporting 31 prospective cohorts, three case-control studies, and three other studies. No page number was available for the indexed passages. (LLM, conf=0.76)

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Cites

Flagged first, then by citations

1 of the 47 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. [3]3. Sattelmair J, Pertman J, Ding EL, Kohl HW, Haskell W, Lee I-M. Dose response between physical activity and risk of coronary heart disease / clinical perspective. Circulation. 2011;124:789-795.
  2. [13]13. Sidney S, Petitti DB, Soff GA, Cundiff DL, Tolan KK, Quesenberry Jr CP. Venous prospective cohort studies. Int J Environ Res Public Health. 2012;9:391-407.
  3. [15]15. R R Rei eimers C C CD, D, D K K Kna na n pp pp pp G G, , Re Re R im im mer er ers s s AK AK. . E Exe xerc rcis ise as s s str rok ok oke e e pr pr p op p phy hy hyla laxi xis. s. Dt D D sc sch h Ar Ar Arzt zteb ebl l In In Int t. . 2 20 00 09 09;106:715 5-7 -721 21 2 .
  4. [30]30. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE E, E, P P Pra ratt tt t M M M, , , Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnai aire re e: : : 12 12 12 c -c -cou o ount n ntry r ry eliability and validity. Med Sci Sport Exer. 2003;35:1381-1395.

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Authors
Armstrong, M. E. G., Green, J., Reeves, G. K., Beral, V., & Cairns, B. J.
Affiliations
University of Oxford (GB)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-02-24
Volume
131
Issue
8
Pages
721-729
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.114.010296
OpenAlex
W2027486850
Semantic Scholar
10c640bea0cb08d8d3047c75660ab95b122073e8
Cited by
219
References
47
Citations by year
2026: 4 · 2025: 16 · 2024: 21 · 2023: 8 · 2022: 18 · 2021: 34 · 2020: 20 · 2019: 25 · 2018: 18 · 2017: 16 · 2016: 22 · 2015: 17
FWCI
17.93
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (publishedVersion, other-oa)
  • Explore Bristol Research (submittedVersion, other-oa)
  • The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
Funders
  • Cancer Research UK (C570/A11692, K02700X, 16491, RE/13/1/30181)
  • British Heart Foundation (RE/13/1/30181)
  • BHF Centre of Research Excellence, Oxford (RE/13/1/30 181)
  • Medical Research Council (13/1/30181, MR/K02700X/1)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
physical activity, vascular disease, coronary artery disease, cerebrovascular disease, venous thromboembolism, stroke, activity frequency, physical activity intensity, women
MeSH terms
Cardiovascular Diseases, Physical Exertion, Female, Follow-Up Studies, United Kingdom, Humans, Longitudinal Studies, Middle Aged, Motor Activity, Prospective Studies, Regression Analysis, Risk Factors, Time Factors, Cohort Studies, Exercise, Incidence

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